When is refraction stable following routine cataract surgery? A systematic review and meta‐analysis

Abstract

Purpose We systematically reviewed the literature to investigate when refraction is stable following routine cataract surgery implanting monofocal intraocular lenses. Current advice recommends obtaining new spectacles 4–6 weeks following surgery. Due to advancements in surgical techniques, we hypothesised that refractive stability would be achieved earlier, which could have major short‐term improvements in quality of life for patients. Methods Medline, CINAHL, AMED, Embase, Web of Science and the Cochrane Library were searched with key words chosen to find articles, which assessed refraction following uncomplicated cataract surgery. Citation chains and the reference lists of all included papers were searched. Unpublished literature was identified using OpenGrey (http://www.opengrey.eu). The review considered studies that measured refraction at regular intervals following surgery until stability was achieved. Results The search identified 6,680 papers. Two reviewers independently screened the abstracts and nine papers were found to fit the criteria, of which five were included in the meta‐analysis. The quality of the papers was evaluated using the Methodological Index for Non‐Randomised Studies (MINORS) instrument. Meta‐analysis of 301 patients’ data of spherical, cylindrical and spherical equivalent correction were performed using Review Manager 5 (RevMan 5.3) (https://revman.cochrane.org/). Refraction at 1‐week versus the gold standard of 4‐weeks showed no significant difference for sphere data (effect size and 95% confidence interval of; ES = 0.00, 95% CI: −0.17, 0.17; p = 1.00), cylindrical data (ES = +0.06; 95% CI: −0.05, 0.17; p = 0.31), and spherical equivalent (ES = −0.01; 95% CI: −0.12, 0.10; p = 0.90). Heterogeneity was non‐significant (I2 < 25%) for all refractive elements. Data were similar for 2‐ versus 4‐weeks post‐surgery. Acquired data from one study highlighted a small number of patients with very unstable cylindrical corrections at 1‐week post‐operatively. Conclusions No statistical difference was found when comparing sphere, cylindrical and spherical equivalent values at 1‐ and 4‐weeks post cataract surgery. This suggests that new glasses could be provided 1‐week after surgery. However, from a clinical perspective, a small number of patients (~7%) from an acquired dataset (N = 72) showed very unstable cylindrical corrections at 1‐week. Further work is needed to determine why this is the case and how these patients can be detected.

Inter-ocular and inter-visit differences in ocular biometry and refractive outcomes after cataract surgery

“…In a subsequent analysis using 186 patients who underwent cataract surgery with Akreos Adapt AO IOL, we found a similar overall result that group D showed a reduced MAE2 (MAE based on the second examination) compared to MAE1 although it did not reach statistical significance, which might be related to small sample numbers (data not shown). Fifth, although previous literature reported that postoperative refraction stabilizes between 1 and 4 weeks following uneventful surgery, the refractive outcome measured at 1-month postoperatively may not be stable, requiring longer-term follow-up [27][28][29][30][31] .…”

Refractive changes and visual quality in patients with corneal edema after cataract surgery

“…It is difficult to find in the literature studies about visual quality of patients with corneal edema after cataract surgery. There is abundant literature concerning clinical refraction stabilization of patients without post-surgical complications [ 23 , 25 ], but the situation changes in corneal edema patients. This may be because poor visual quality in these patients is assumed, and because visual quality depends on the severity of corneal edema, introducing large variability in the samples.…”

The relationship between angle kappa and astigmatism after phacoemulsification with implanting of spherical and aspheric intraocular lens

“…The mean astigmatism remained stable over both periods, and this supports a more recent conclusion. [ 23 ] A change in astigmatism from + 0.25DCX100 to + 0.50DCX30 appears insignificant, but the difference in the axis results in an induced change in astigmatism of + 0.71DCX23. This example illustrates why the induced astigmatic powers, in Tables 1 and 2 , exceeded the difference in mean astigmatic powers revealed by refraction.…”

“…Could a change in K after phacoemulsification impact on the astigmatism revealed by refraction? The refractive error is moderately stable 1 week after uncomplicated phacoemulsification,[ 23 ] but changes in astigmatism are not unusual more than 1 month later. The normal corneal surface is elliptical[ 24 25 26 ] and the off-axis astigmatism can be estimated.…”